• Korean Journal of Radiology
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• v.21 no.10
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• pp.1178-1186
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• 2020

Objective: To evaluate the incidence and risk factors of emetic complications associated with the intravenous administration of low-osmolality iodinated contrast media (ICM) in children undergoing computed tomography (CT). Materials and Methods: All children who underwent contrast-enhanced CT between April 2017 and July 2019 were included. Pediatric patients were instructed on the preparative dietary protocol at our institution. Experienced nurses in the radiology department monitored the children during the CT scans and recorded any emetic complications in their electronic medical records. These data were used to calculate the incidence of emetic complications. Various patient factors and technical factors, including fasting duration, the type and volume of ICM, and ongoing chemotherapy, were evaluated to identify risk factors for emetic complications using univariate and multivariate logistic regression analyses. Results: Among the 864 children (mean age, 8.4 ± 5.7 years) evaluated, 18 (2.1%) experienced emetic complications (6 experienced nausea only and 12 experienced nausea and vomiting). None of the children developed aspiration pneumonia. The mean fasting duration of patients with emesis was 7.9 ± 5.7 hours (range, 3-21 hours), whereas that of patients without nausea was 8.7 ± 5.7 hours (range, 0-24 hours). Fasting duration was not associated with the development of nausea and vomiting (p = 0.634). Multivariate logistic regression analysis revealed that ongoing chemotherapy (odds ratio [OR] = 4.323; 95% confidence interval [CI] = 1.430-13.064; p = 0.009), iomeprol use (OR = 7.219; 95% CI = 1.442-36.146; p = 0.016), and iohexol use (OR = 5.241; 95% CI = 1.350-20.346; p = 0.017) were independent risk factors for emetic complications. Conclusion: Only a small proportion (2.1%) of children experienced nausea or vomiting after exposure to low-osmolality ICM. Many children underwent excessive fasting; however, fasting duration was not associated with nausea and vomiting. Moreover, ongoing chemotherapy and the use of iomeprol or iohexol were identified as potential risk factors for emetic complications in children.

• Journal of The Korean Astronomical Society
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• v.36 no.3
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• pp.111-121
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• 2003

In order to explore the cosmic ray acceleration at the cosmological shocks, we have performed numerical simulations of one-dimensional, plane-parallel, cosmic ray (CR) modified shocks with the newly developed CRASH (Cosmic Ray Amr SHock) numerical code. Based on the hypothesis that strong Alfven waves are self-generated by streaming CRs, the Bohm diffusion model for CRs is adopted. The code includes a plasma-physics-based 'injection' model that transfers a small proportion of the thermal proton flux through the shock into low energy CRs for acceleration there. We found that, for strong accretion shocks with Mach numbers greater than 10, CRs can absorb most of shock kinetic energy and the accretion shock speed is reduced up to $20\%$, compared to pure gas dynamic shocks. Although the amount of kinetic energy passed through accretion shocks is small, since they propagate into the low density intergalactic medium, they might possibly provide acceleration sites for ultra-high energy cosmic rays of $E\ll10^{18}eV$. For internal/merger shocks with Mach numbers less than 3, however, the energy transfer to CRs is only about $10-20\%$ and so nonlinear feedback due to the CR pressure is insignificant. Considering that intracluster medium (ICM) can be shocked repeatedly, however, the CRs generated by these weak shocks could be sufficient to explain the observed non-thermal signatures from clusters of galaxies.